Uterine fibroids are benign tumors that may grow in various regions of the uterus of a woman. They are relatively common and affect 20% of childbearing women and half of all women by the age of 50.

Size and Location

Fibroids can vary greatly in size, ranging from microscopically small to several pounds in weight and big enough to fill the womb. Additionally, a single fibroid may develop or several may be formed.

Fibroids are classified according their location in the womb. This includes:

• Myometrial in the uterine muscle wall
• Submucosal under the uterine lining surface
• Subserosal under the outside uterine lining
• Pedunculated on a long stalk inside or outside the uterus

Cause

The specific cause of fibroids is not known with precision, as there are believed to be several factors that may lead to the formation of the tumors. These include hormones such as estrogen and progesterone, as well as genetic mutations.

Women with uterine fibroids may notice that they grow in size when they are pregnant, due to the hormonal changes. This can cause more severe symptoms, which usually return to their original state after the birth of the baby.

Symptoms

The severity of presenting symptoms differs greatly between affected women and is associated with the size and number of uterine fibroids. Symptoms may include:

• Spotting or bleeding between periods
• Heavy bleeding, sometimes with clots, during period
• Longer period
• Frequent urination
• Severe pelvic cramping
• Abdominal pain
• Pain during sexual intercourse

For some women, the fibroids will shrink after menopause due to changes in hormonal levels, which usually brings about a reduction in symptom severity.  

Diagnosis

It can be difficult to diagnose fibroids and usually requires are series of examinations. These may include:

• A pelvic exam to determine changes in shape of the uterus
• An ultrasound to depict the shape of the uterine wall and fibroids
• Magnetic resonance imaging (MRI) to create image of area
• Hysteroscopy examines the uterus internally with a tube inserted via the vagina
• An endometrial biopsy to examine the cells for malignant properties.
• Laparoscopy examines the uterus with a tube inserted via a cut in your stomach

Treatment

The treatment for a woman with uterine fibroids depends on her age, symptoms and specific circumstances. The type of fibroids, other health condition and intention to bear children in the future may all have an impact on the treatment decision.

The oral contraceptive pill (OCP) is often helpful for women that experience heavy periods due to hormonal levels in their body. Other methods of birth control, such as hormonal intrauterine devices (IUDs) can also offer a benefit. Hormonal therapy can also be used for a short time to help shrink the size of the fibroids, hence leading to a reduction in symptoms.

Symptomatic treatment can also be applied for specific reasons. For example, analgesic medications such as ibuprofen, naproxen or other NSAIDs can help to relieve related pain. If the woman displays symptoms of anemia due to heavy bleeding, iron supplements may be of benefit.

It is important that women with uterine fibroids are aware that they may grow in size and cause the symptoms to worsen. If they notice signs of progression, they should seek further tests in order to receive adequate treatment.

There are several surgical procedures that may be undertaken in some cases, including:

• Hysteroscopy to surgically remove the fibroids
• Uterine artery embolization causes an obstruction of blood flow to the fibroid, leading to cell death
• Myomectomy to remove the fibroids from the uterus
• Hysterectomy to remove the entire uterus.

References

• http://www.nlm.nih.gov/medlineplus/ency/article/000914.htm
• http://womenshealth.gov/publications/our-publications/fact-sheet/uterine-fibroids.html
• http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072719/